| Doctor Name: | DR. SHANE NATHANIEL MCCAULEY |
| NPI Number: | 1083603229 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | 01059435A |
| Business Practice Address: | 243 Curtiss Rd 100 Barksdale Afb, LA - 711102425 |
| Business Phone Number: | 3184564318 |
| Business Fax Number: | |
| Mailing Address: | 121 Baltic Dr, SHREVEPORT |
| State: | LA |
| Postal Code: | 711152912 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 10/20/2005 |
| NPI Last Update Date: | 09/24/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 171000000X |
| License Number: | 01059435A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Military Health Care Provider |
| Taxonomy Specialization: | |
| Taxonomy Definition: | Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes. |